51123LOT
NO.
�® �RPIQ FOR PLUMBING PERMIT
JITY OF CUPERTINO
I
OCT 2 0 11965 Gs� Sanitary \'u. n
Date October 1$, T965 , 196_ Permit No L�//�
QITY .OF %Ltff I INQ Fees 3.00
pplication Is here y made tote City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Ownw,r-131Fnrd- S_
By Sears, P.oebuck and Co.
CONTRACTOR, AGENT
Phone 369-1751
State License 25455
Address 10720 Pinole Ct.
Address 1325 Douglas Ave. , RC
Approved WILLIAM D. 6ENEVICH
PLUMBING INSPECTOR
NITS FEES
Main
V a Ives
RECORD OF INSPECTION
Underground Rough...
Partial Rough -
Rough. Complete -
Main Drain
Final....